Improving the Oral Health of Older People in Care Homes: Results From a Randomised Feasibility Study

Poor oral health is a considerable burden for older adults in care homes. The National Institute for Health and Care Excellence (NICE) issued guideline NG48 on "Improving oral health in care homes". However, empirical evidence for oral health interventions among care home residents is weak, and the feasibility of the NG48 recommended interventions is not established. This study aimed to determine the feasibility of delivering a co-designed oral health intervention, based on NG48 recommendations, in care homes in two sites in the UK.

This was a pragmatic cluster randomised controlled feasibility study with a 12-month follow-up, undertaken in 22 care homes across two sites (11 each in London and Northern Ireland). Care homes were randomised to an intervention arm (n = 11), and a control arm (n = 11) that continued with usual routine practice. The complex intervention contained materials were co-designed with care home staff and consisted of: care home staff training package; Oral Health Assessment Tool (OHAT) administered by trained care home staff; and a support worker assisted twice daily tooth-brushing regimen with 1500 ppm fluoride toothpaste. Rates of recruitment and retention, data completion, and intervention fidelity were recorded to determine feasibility.

One-hundred-and-nineteen residents from 22 care homes were recruited and 82 residents from 19 care homes completed the study (retention: 86% for care homes and 69% for residents). Twenty residents were lost to follow-up and another 17 withdrew throughout the study. Data completion rates ranged between 88% and 97% at baseline and between 91% and 96% at the 12-month follow-up. Intervention fidelity records showed high completion rates for oral care plans (90%), and lower rates for weekly oral hygiene records (73%) and the OHAT (61%).

This study documented the feasibility of an oral health intervention in care homes, while also highlighting issues to consider for a definitive trial to assess the effectiveness of the co-designed intervention.

Clinical Trial Registration: ISRCTN10276613.